Deadly drug-resistant Japanese fungus detected in UK hospitals

Victoria Tan, 21 Aug 2017

Candida auris is fast emerging as a serious global health concern.

A deadly fungus by the name of Candidaauris has reared its ugly head in the UK, infecting more than 200 patients in 20 separate hospitals across the country as of July 2017. Another 35 hospitals have been known to have received patients with known C. auris infections.

So far, no deaths have occurred during the current outbreak. However, hospital staff are on high alert as the previous outbreaks "have proved difficult to control, despite intensive infection prevention and control measures", as reported by Public Health England (PHE).

The PHE has since issued a nationwide health alert for strict vigilance of C. auris cases.

Only 25% of C. auris positive patients have clinical infections

Despite staggering high numbers, most of the infected patients of this outbreak are asymptomatic carriers. “Most cases detected have not shown symptoms or developed an infection as a result of the fungus,” reports Dr Colin Brown, a microbiologist in PHE’s national infection service.

“The kind of patient that gets infected by this will normally already be immunosuppressed,” says Professor Hugh Pennington, an emeritus professor of bacteriology at Aberdeen University. He adds that C. auris infections are ‘a nightmare’ especially for intensive care units.

It was reported that out of the 25% of patients with C. auris, 27 of them have developed blood stream infections. C. auris infections have appeared sporadically across England since 2013. A massive outbreak in the Royal Brompton Hospital last year witnessed almost 50 patients that were infected. As a result, the hospital was forced to close its intensive care unit for two weeks as it fought to gain control of the infection.

C. auris known to be resistant to all three main classes of antifungals

The Centers for Disease Control and Prevention in the United States (CDC) is greatly concerned with the rise of C. auris as it has been proven to be multi-drug resistant. Furthermore, current diagnostic methods frequently fail to accurately detect C. auris. More detailed molecular analysis technology that is not widely available is necessary for correct identification.

C. auris also differs from other pathogenic yeast infections in its predilection for spreading like wildfire in the hospital setting. Studies have attributed this to persistent C. auris colonisation on the skin and other body sites weeks to months after the initial infection, possibly leading to contamination of the healthcare environment.

All C. auris isolates in the U.K. have confirmed to be resistant to flucanozole, with variable susceptibility to other anti-fungal agents. Continuous susceptibility testing is vital.

Fungus was first identified in Japan, in 2009

Since its detection in 2009, the C. auris fungus has spread globally to the United States, South Africa, Kuwait, India, Pakistan, Venezuela, Colombia and South Korea. In 2016, the U.S. reported its first 13 cases of C. auris. The current number of cases stands at 98, with most of its cases in New York and New Jersey.

Interestingly, molecular analysis of international C. auris strains have revealed distinct differences across regions. These differences suggest that C. auris may have developed independently in these areas at about the same time. The CDC notes that travel to these countries do not increase the likelihood of infection, as C. auris primarily affects those already in the hospital setting.

Invasive C. auris infections have resulted in candidaemia, wound infections and ear infections. Although it has been commonly isolated from the urogenital and respiratory tracts, it is unclear if it causes lung or bladder infections. C. auris can infect patients from all ages. MIMS

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